The aim of the present study was to examine how children attending the middle years of the primary school understand and extend mathematical patterns. A total of 90 students coming from grades C (N=48) and D (N=42) were asked 21 pattern tasks that were designed on the basis of two main categories (visual patterns and number patterns) and were further divided into: a) repeating visual and repeating number patterns, and b) growing visual and growing number patterns. Participants were asked to identify the pattern rules and extend the patterns by filling the missing steps. They also had to make a pattern on their own. Overall results showed similarly high performance on visual and number pattern tasks. However, the majority of the participants had a higher rate of success in repeating visual patterns and repeating number patterns compared to growing visual patterns and growing number patterns. The analysis of the strategies that children implemented in patterning revealed a great differentiation between their use and the type of pattern. More specifically, students mainly justified their pattern extensions by making reasonable connections within successive steps in the growing pattern tasks, whereas they tended to use techniques related to random predictions following repetitions of the pattern’s parts in the repeating pattern tasks. Last, participants’ preference for repeating visual patterns was found when making their own patterns.